The candidate, Dr. Jerome Kowal, has achieved the major objectives set forth in the original proposal for the Geriatric Leadership Academic award he received in 1985. A broad spectrum of clinical activities have been established which include a free-standing multidisciplinary ambulatory program at University Hospital, inpatient and ambulatory geriatric evaluation units at the Cleveland VA Medical Center and programs in affiliated long-term care institutions. Six full-time trained geriatric faculty have been recruited and a strong neurobehavioral program has been developed by University Hospital to interface with the Geriatric Program. The Western Reserve Geriatric Education Center (WRGEC), funded by the Bureau of Health Professions has provided the opportunity for Dr. Kowal to implement a wide variety of continuing education programs at the graduate and postgraduate levels. Education offerings in aging for medical studies have been expanded and elective rotations have been established for internal medicine and family medicine residents. Six students have received training under this award in Dr. Kowal's laboratory. The Fellowship program in Geriatric Medicine has grown to four fellows in 1987-88. Twelve laboratories involved in aging research at CWRU participated in a proposal to the NIA for a multidisciplinary Research Fellowship Training Program, with Dr. Kowal as principal investigator. The program was funded for four years to train physician scientists. Eight scientists, who had never worked in aging, submitted startup aging grant proposals as part of a proposal, submitted by Dr. Kowal for a Geriatric Research Education and Clinical Center (GRECC) at the Cleveland VA Medical Center. The candidate proposes to expand his own research activities, build a research base for the Division of Geriatric Medicine through the recruitment and training of research faculty, and to undertake new initiatives in education, clinical care and financial support for the programs. This proposal describes both short and long range plans for research in Dr. Kowal's laboratory, which utilizes the adrenal cell as a model for aging related abnormalities of intracellular cholesterol regulation. New educational initiatives by the candidate include instituting required geriatric rotations in the Medicine and Family Medicine residency programs, incorporating "aging" components into the medical school preclinical and clinical curricula, extending the activities of the WRGEC, and assisting the Dental School to develop programs in geriatric step-down unit, as well as a new initiative to train healthcare professionals in the development of future networks with selected community hospitals. These objectives are an extension of the programs developed during the initial three years of the GLAA. Continued support will greatly facilitate their accomplishment during the next three years.